Quality & Accreditation Specialist

Position Summary

The NCQA Specialist coordinates quality improvement activities and supports various functions within the scope of the Plan quality improvement program, working both independently and as a team member. The functions may include but are not limited to committee support; regulatory and accreditation standard adherence; delegation oversight; performance monitoring and assessment; data collection and analysis; and the continual advancement of the quality improvement process to achieve the Health Plan's goals of excellence.

Essential Functions and Responsibilities

• Accountable for assigned standards from National Committee for Quality Assurance (NCQA), which may involve oversight of delegated activities.
• Works with Plan departments, such as Quality, Contracting, Provider Relations, Member Services, Appeals and Grievances, Pharmacy Services, Utilization and Medical Management, Credentialing, and other departments and delegates to ensure that NCQA standards are met, and appropriate documentation is maintained.
• Counsels, guides and instructs Health Plan employees on adherence to accreditation standards, NCQA-focused activities and other quality improvement initiatives.
• Supports the Plan committee functions and activities as assigned. Ensures that meetings are organized, well documented and that they meet the Plan goals and objectives and the individual Committee's roles and responsibilities.
• Led quality projects as directed, including appropriate audits and state projects and requirements.
• Assumes project management as directed.

Qualifications

• Associate degree in a health care field or equivalent work.
• Four (4) years' experience with a government regulated health organization or a managed care setting with at least two (2) years’ experience performing complex quality management activities including HEDIS, NCQA etc.
• Preferred: Bachelor’s in healthcare or related field. Experience writing quantitative and qualitative analysis. Knowledge of the National Committee on Quality Assurance (NCQA) Standards for the accreditation of managed care organizations and HEDIS specifications; the managed care environment and the basic tenets of continuous quality improvement.